For research to be a core value, it cannot remain the province of a small cadre of our members. 1
For years, family medicine leaders have been urging members to increase research productivity and promote a strong research culture. Still, research inhabits a tiny corner of the family medicine world, concentrated in academic centers. Most residents (84%) graduate from community residency programs, and most of these lack the resources to promote research among faculty and residents. How can we expect our graduates to appreciate, support, and participate in research when the great majority has little exposure?
In the middle 1990s, these concerns led us to examine our own back yard. While our university faculty were research-friendly, our department had done little to spread these values beyond our walls. To correct this situation, we applied to the US Health Resources and Services Administration (HRSA) and received funding in 1997, 2000, 2003, and 2009 to support the Residency Research Network of Texas (RRNeT). We proposed a two-fold mission: to examine health issues relevant to family medicine patients in Texas; and to increase community program faculty and residents’ involvement in research.
INFRASTRUCTURE
RRNeT held its first meeting in March 1998 with 5 residency programs; membership now includes 10 programs. Together, our programs employ about 100 family physician faculty and train 290 residents per year. Our clinicians see approximately 300,000 outpatient visits per year, including 60% Latino, 15% African-American, and 22% white patients. RRNeT membership requires the endorsement and commitment of the program director, who designates 1 or more faculty to represent the program on the RRNeT Steering Committee. RRNeT communicates via list-serve frequently, by conference call every 2 months, and face-to-face during 2 meetings per year.
Funding is modest. HRSA provides salary support to the Director and Coordinator at the University of Texas Health Science Center at San Antonio (UTHSCSA), and funds travel to RRNeT meetings and national conferences for dissemination. The Texas Academy of Family Medicine, the Office of the Medical Dean at UTHSCSA, and the Area Health Education Center (AHEC) provide support for student research assistants. Currently, RRNeT has a pilot grant from the UTHSCSA Center for Translational Science Award to support a study about chronic low back pain.
PROCESS
RRNeT conducts about 1 project per year, on average. The turnaround is quick, about 1 year from idea generation to data analysis. Participation is informal, collaborative, and non-mandatory, but programs rarely opt out. Our network prefers research questions that come from community program clinicians, not from university investigators. The Steering Committee meets to brainstorm and prioritize research ideas, then develops a skeleton research protocol through large group discussion. A “content expert” is identified and recruited onto the planning team (if not already a member); then 1 or 2 individuals draft the protocol which provides the format for IRB applications and grant proposals. Our 10 programs have 10 IRBs, so we develop model protocols and consent forms; Steering Committee members are responsible for adapting these documents for their own institution.
RRNeT Steering Committee members oversee data collection at their sites. We have used varying methods, including patient and physician surveys, “pocket cards,” chart reviews, and qualitative long interviews. Data are entered into a central database, cleaned, and translated into SPSS (Statistical Package for the Social Sciences). Data files are “owned” by the network and shared with Steering Committee members on request. Data analysis is usually (but not always) conducted by the network Director at UTHSCSA, with assistance from departmental statisticians. Dissemination has 4 steps: findings first go to the Steering Committee; then to the practices; to national conferences; and finally as published journal articles.
OUTCOMES
Over 12 years, RRNeT has examined several topics: complementary and alternative medicine use; quality of diabetes care; brief interventions for medication adherence and for safe firearm storage; preventive care for adolescents; health behaviors; management of nonmalignant chronic pain; chronic low back pain; and stories of efficiencies in the health care system. We have published 6 journal articles and 7 abstracts; presented 32 presentations to national conferences; and won 8 research awards, 3 to medical students and 5 to community residency faculty.
CONCLUSIONS
RRNeT provides a centralized university-based infrastructure, a link to research resources, and an engine to move projects forward. This allows busy clinical teachers to participate actively in research while maintaining their curricular and patient care responsibilities. The benefits to community programs include: a peer group of researchers; links to career investigators and statisticians; hands-on research experience; opportunities to present and publish; national exposure for the training programs; and documentation for involvement in research for accreditation purposes. The advantage to university faculty is a large and diverse patient population with a thoughtful, collaborative team of clinical teachers. Now, THIS is science!
- © 2010 Annals of Family Medicine, Inc.
Related Articles
Cited By...
- No citing articles found.